Prehospital Minithoracostomy versus Chest Drainage for Emergency Pleural Decompression in Major Trauma

Prehospital pleural decompression is life-saving in patients with suspected tension pneumothorax or other life-threatening thoracic pressure pathology after major trauma. Although prehospital minithoracostomy (PHMT) is increasingly adopted by physician-led helicopter emergency medical services (HEMS), comparative evidence with prehospital chest drainage (PHCD) remains limited.

We conducted a retrospective observational cohort study of consecutive adult trauma patients undergoing prehospital pleural decompression within a physician-led HEMS between January 2018 and December 2024, managed with PHMT or PHCD according to clinical judgment. The primary outcome, scene time, was analyzed using Bayesian robust Student-t regression; recorded complications and survival were analyzed using Bayesian beta-binomial models, with posterior risk differences and credible intervals.

Ninety-four patients were included (66 PHMT; 28 PHCD). After excluding two implausible zero-minute scene-time records, the posterior median difference in scene time was -5.9 minutes (95% credible interval [CrI], -13.8 to 1.7; 94.0% probability PHMT was shorter). Complication status was evaluable in 50/66 PHMT and 10/28 PHCD patients. Recorded complications occurred in 0/50 evaluable PHMT and 6/10 evaluable PHCD patients (risk difference -58.7 percentage points, 95% CrI -83.9 to -29.3; probability >99.9% that recorded complications were less frequent with PHMT). Prehospital survival was lower with PHMT, reflecting greater baseline severity, whereas no clear differences were observed at 1, 30, or 90 days.

Prehospital minithoracostomy was not associated with longer scene time and was associated with fewer recorded complications than PHCD. Because allocation was non-randomized, complication ascertainment differed between procedures, and few events occurred, these findings are hypothesis-generating rather than evidence of comparative safety. Prospective multicenter studies with standardized indications and systematic outcome assessment are warranted.